Guest post by Jeff Weiss, MD
As a pediatric hospitalist at Phoenix Children’s Hospital, I have cared for many children who were non-fatal drowning victims. The stories are all tragic: Severe brain damage. Ventilators and feeding tubes. Frequent hospitalizations. Family guilt and blame, and frequent divorce. All preventable, if someone had just been watching, or had put up a fence, or had been taught to swim, or had put on a life vest, or had not been left alone in a bathtub, or had taken a CPR class.
Statistics say the highest rates of drowning deaths are in toddlers (ages 1-4) and adolescent boys. Black and Native American kids are at higher risk, but I have seen kids of all ages and genders and backgrounds. Statistics don’t really matter much if it’s your kid who drowns.
Most kids are developmentally ready to learn to swim by age 4. I was on the American Academy of Pediatrics Committee on Injury, Violence, and Poison Prevention in 2008 when I was assigned the job of revising the Drowning Prevention Policy Statement. Up to that time, the AAP recommended against swim lessons for children under age 4 for fear that parents would have a false sense of security and would relax their supervision around water. Research shows this concern to be valid.
In 2009, an important study was published that showed kids ages 1-4 who drowned were less likely to have had swimming lessons than a group of similar-age kids who had been taught to swim. There were no details about what types of swim programs were best, and there was no information about infants under age 1. Based on this study and two others from Asia, the Committee recommendation against swim lessons until age 4 was relaxed, but there was not enough evidence to recommend that all children 1-4 should get swim lessons at that early age.
Now the AAP says, “a parent’s decision about starting swim lessons or water-survival skills training at an early age must be individualized on the basis of the child’s frequency of exposure to water, emotional maturity, physical and cognitive limitations, and health concerns related to swimming pools.”
It is important to remember that even proficient swimmers can drown. Swimming in a pool while wearing a bathing suit is not the same as falling into a pool or lake with all your clothes and shoes on. During falls, people can hit their heads, or panic, or become confused (with adolescents, often from alcohol), which can make their swimming skills useless.
It’s easy to say that parents should always watch their kids carefully around water, but this is easier said than done! One of my patients drowned when his mother went to comfort a sibling who was crying from a scraped knee. Another drowned when his father went to answer the phone. In an instant, a child can fall into a pool and submerge silently below the water’s surface where they can’t easily be seen.
Some experts have suggested there should always be a designated and identified “water watcher” who is responsible for pool safety and is expected to fully disengage from any distracting activities. Unless there is an older, mature adolescent you can trust to supervise, remove all children from the pool area before attending to any other tasks. When the phone rings, let it go to voicemail!
Pool fencing is an effective way to decrease pool drownings, because it keeps kids out of the pool area when they are not supposed to be there. The fence should be at least 4-feet high, have a self-closing, self-locking gate, and should completely enclose and isolate the pool area. I have cared for several drowning victims where a young child got out of the house through a sliding door or through a “doggie door” to enter the backyard pool.
Unfortunately, the laws in Arizona do not require that the pool fence be built to prevent pool access from the back of the house. And don’t forget, young children also need effective barriers to keep them out of hot tubs and above-ground pools.
Here in Arizona, we often think only of swimming pools when we think of drowning, but we also should consider beach and boating drownings. Properly fitting life jackets are a well-proven prevention method.
Although rare, in-home drownings also occur. Young children can fall into buckets and toilets, but being left alone in a bathtub is by far the biggest cause of in-home drowning. Baby bath seats and bath rings can be a big problem, because they can tip over and trap the baby under the water. Infants should always be with an adult when in a bath.
An important role of a physician is to advise families about childhood drowning and injury prevention. The problem is that several studies show that there is little time during an office visit for such counseling and that it is only marginally effective anyway.
I believe that much of the problem is that doctors often focus on “why” people should do something rather than details of “how” to do it. For instance, rather than saying, “Get a pool fence so your kid doesn’t drown,” a better approach might be, “Many of my patients have used ABC fence company. They have a variety of attractive styles at reasonable prices. They get the work done fast, and everyone has been happy with the results. Here’s their phone number.”
Or for swim lessons: “Many of my patients have learned to swim at Sally’s Swim School. They have classes for all ages and are reasonably priced. They involve parents in water safety education, and they are very good dealing with kids who are afraid of water. Here’s how to contact them.” And for life jackets: “Big Bob’s sport store on Washington Street sells Coast Guard-approved life jackets for kids for about $25. There is someone there who knows how to fit kids properly. Other patients of mine have been pleased.”
A counseling approach focusing on the “how” rather than the “why” comes from studies by Albert Bandura and his Social Learning Theory. I have been using this technique and teaching it to medical students, interns, residents and pediatricians for many years, and I think patients and families appreciate this approach.
Jeff Weiss graduated from Jefferson Medical College in Philadelphia 1971 and did his pediatric residency at Nationwide Children’s Hospital in Columbus, Ohio. Following a two-year stint in the U.S. Army, Dr. Weiss returned to Jefferson, where he joined the medical school faculty. In 1993, he moved to Phoenix and in 1995, he became the Chief of General Pediatrics at Phoenix Children’s Hospital and Professor of Clinical Pediatrics at the University of Arizona College of Medicine. Dr. Weiss served on the American Academy of Pediatrics Committee on Injury, Violence, and Poison Prevention for six years, during which time he authored policy statements on drowning prevention, teen drivers, and pedestrian injury. Dr. Weiss retired from his position as a Pediatric Hospitalist at PCH in April of 2021 and is currently spending more time with family, trying to improve at golf, and riding his bike 20-30 miles almost every day. He is also working hard on his laser-cut artwork and is proud that he had a piece accepted to a juried show at the Herberger Theater Art Gallery. You can check out his art at jeffweissart.com.
Water safety resources
June, July and August are peak times for child drownings in Arizona. Safety experts recommend creating many “layers of protection” to prevent such tragedies — from swim lessons for young children to reliable pool barriers to designated water watchers. Here are tips for keeping kids safe around water from the Drowning Prevention Coalition of Arizona:
- Always stay within an arm’s reach of a child near the bathtub, toilet, pool, spa or buckets. Never leave a child alone or in the care of other children during bath time.
- Empty/drain all bathtubs, buckets, containers, and wading pools immediately after use.
- Keep toilet lids closed and use toilet seat locks. Keep doors to bathrooms and laundry rooms closed.
- Never leave a child unattended in a tub or around any other body of water, even if he or she knows how to swim. Children in baby bath seats and rings must be watched every second.
- Small children can fit through a pet door. Be sure the doggie door does not lead directly to the pool area.
- Consider swimming lessons for young children in a facility that is clean, well-staffed and emphasizes other layers of protection (such as supervision) as part of a complete water safety plan.
- Install a barrier that meets safety standards around a pool or spa, including self-latching, self-closing gates with fences 5-feet high completely separating the pool from the backyard and house. Always lock the gate and never prop the gate open.
- Do not allow children to play in or around the pool area, and keep tables, chairs and ladders away from pool fences.
- Install door alarms to sound if a child goes out to the pool area.
- Mount life-saving devices near the pool and always have a phone near the pool area.
Drowning Prevention Coalition of Arizona (preventdrownings.org) offers drowning statistics and water safety tips, resources and events to reduce drownings.
Phoenix Children’s Hospital’s Water Safety Program (phoenixchildrens.org/center-family-health-safety/water-safety-program) offers free water safety kits and “Playing it Safe” workshops where parents can create a water safety plan.
Water Smart Babies (watersmartbabies.com). On a child’s nine-month and 1-year well visits, his or her pediatrician writes out a “Doctor’s prescription” for water safety lessons and parents get a handbook with tips on home water safety, water safety lesson facilities, CPR classes and safety devices, such as pool fencing and door and pool alarms.